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Injuries in Singapore: ACL tears, robot surgery and foot fallacies

By: Amy Greenburg

We all know playing sports contributes to a healthy lifestyle, but it also means inevitable wear and tear on our bodies – and the unfortunate likelihood of painful problems as a result. We had specialists from The Orthopaedic Centre weigh in on a range of issues from joint replacements and surgical treatment for ligament tears to common misconceptions about foot and ankle injuries.

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ACL Surgery: What to Know
A torn anterior cruciate ligament (you know it as an ACL) is, more often than not, related to a high impact sport – think rugby, soccer, netball, football, basketball and martial arts – or when the knee is forced to stop suddenly at high speed. DR TAN CHYN HONG fills us in on the latest in surgical treatment options for this painful problem.

So, what can be done for an ACL tear?
Treatment for such an injury requires a team approach involving surgeons, sports physicians and physiotherapists. Knee injuries like ligament tears might need reconstruction, which usually involves keyhole surgery (also known as an arthroscopy) to replace the torn ligaments. This is a minimally invasive procedure where we use a camera and specialised equipment to conduct surgery through small incisions, without having to open up the joint. This type of surgery is especially useful for professional athletes, who frequently injure knee joints and require quick healing time. Keyhole surgery’s also used to treat shoulder injuries including dislocated joints and rotator cuff tears.

What are the advantages of keyhole surgery?
The benefits include less pain, minimal trauma to the connective tissue, less bleeding, faster recovery time and better cosmetic results, since the incision is small and, therefore, leaves less of a scar.

So, how much downtime are we talking?
A typical anterior cruciate ligament reconstruction will take nine months to a year before the patient can return to sports.

Is complete reconstruction surgery always necessary?
ACL tears aren’t always complete ruptures. We can now selectively reconstruct the torn part while leaving the uninjured part alone. This “selective bundle ACL reconstruction technique” makes a lot of sense because there’s really no need to remove the healthy uninjured tissue. Nobody can do a better job than Mother Nature!

Any tips for preventing knee injuries altogether?
Always consider cross training rather than doing the same exercises every time. If you run everyday and start feeling pain in your knees, consider swimming or cycling instead, to reduce stress on the knees.

 

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Painful Problems You’re Not Dealing with Properly
We thought it was high time to set the record straight on some of those common misconceptions (er, excuses) that are keeping you from leading an active lifestyle. We had foot and ankle specialist, DR DAVID SU, do the honour.

“It can’t be broken, because I can walk on it.”
This is false, as it really depends on one’s pain tolerance level. I’ve seen patients limping around for weeks with foot fractures, and then stared at me with disbelief when we reviewed x-rays that showed displaced foot fractures. It’s probably better news than bad if you can walk without pain, but limping around with discomfort is probably a warning sign that more may be afoot. Many people go though life suffering from foot and ankle pain, having been wrongly advised that they must live with it and that nothing can be done. Luckily, we now live in a time where scientific knowledge and technology have given us the ability to properly understand foot and ankle problems. A specialist can tailor a specific treatment plan varying from rest, activity modification, physiotherapy, podiatrist evaluations, chiropractic reviews, orthotics and, if necessary, surgery for the patient.

Bunions recur no matter what.
This doesn’t have to be the case. Nowadays, foot reconstruction options allow for minimal downtime without immobilization, minimal pain in the post-op period and next to no recurrence, allowing patients to return to sports activities as soon as possible. Also, thanks to our present day understanding of how to deal with bunions, modifying footwear and activities can allow patients to cope with the discomfort arising from bunions.

“I have no choice but to live with heel pain.”
There are many causes of heel pain but plantar fasciitis is the most common. Often, calf and plantar fascia stretching can allow for relief of the discomfort, and maintaining a healthy weight also helps. However, there are some patients whose muscles are simply too tight for stretching to be effective, and some whose conditions simply prevent regular exercise. In these groups of patients, a minor operation can provide excellent relief, allowing the patient to return to sports activities.

 

Do the Robot
Hip and knee specialist, DR CHIN PAK LIN, is an advocate of computer-aided orthopaedic surgery and robotic knee surgery for his patients’ joint reconstruction procedures. So, why computer-aided and robotic, as opposed to good, old-fashioned surgery? Unparalleled precision, to be exact – Dr Chin explains.

“The incidence of joint problems, particularly of the hip and knee (osteoarthritis and sports-related injuries, for example), has grown significantly over the years. Luckily, orthopaedic surgeons now have a plethora of new treatment modalities, as opposed to four decades ago, when a patient in his or her thirties with a damaged joint would have been advised to live with the pain and come back in 20 years time.

Technological improvements have allowed joint specialists like myself to offer stem cell therapy and cartilage regeneration techniques that are minimally invasive and have little down time. In fact, there are various “bespoke” options for partial joint destruction of the knee, like unicompartmental resurfacing techniques, as well as total joint replacement, depending on a patient’s condition.

Though ‘minimally invasive surgery’ is a buzz phrase these days, safely executing minimally invasive procedures really hinges on the precision and experience of the surgeon. However, even the most experienced knee surgeon is only 70-percent accurate in achieving the ideal alignment. Thanks to computer-aided and robotic surgeries, precision surgery provides real time, objective assessment and feedback while minimizing errors of judgment; state-of-the-art 3D imaging allows us to see bony landmarks accurately, without any second-guessing in a bloody field, thus reducing medical errors.

Having experienced computer-aided surgery first-hand, I’ve seen the positive outcomes from this type of technology. Robotic surgery, also a form of computer-aided surgery, takes it a step further in its precise execution of cuts – it’s dead-on accurate and certainly does what it’s programmed to do, allowing for small incision wounds to be made without exposing the bones. It boasts the accuracy of up to 0.7 millimetres, unrivalled by any human hand. After all, surgical outcomes shouldn’t have to be a lottery.”

 

 

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